OUR OPINION: The clients are missing in the Medicaid impasse

Mississippi’s standoff between proponents and opponents of Medicaid expansion expands in dramatic dimensions almost daily, with Gov. Phil Bryant saying he will run the agency by executive order rather than give in to supporters of expanding the program under new eligibility limits in the Affordable Care Act, which takes effect Oct. 1.
Bryant’s position generally reflects his Republican Party’s opposition to even a legislative debate about adding as many as 300,000 Mississippians. Legislative Democrats, on the other side, generally support expansion.
So far, little has been said about the consequences for the program’s 640,000 current clients.
Politics so far trumps patients – those 640,000 people who are primarily the disabled, poor pregnant women, poor children and the elderly.
The additional 300,000 who would be eligible under expanded coverage aren’t in the equation except as a footnote about uncompensated care provided by hospitals already hard-pressed to stay financially afloat.
Gerald Wages, the former chief financial officer of North Mississippi Medical Center, an expert in hospital finance, said Thursday, “A lot of small hospitals in the state are going to have a challenge keeping their doors open.”
Wages is a former chairman of the Mississippi Hospital Association, whose institutional members stand to lose vast sums in reimbursement from Medicare and disproportionate share payments, targeted at hospitals with high levels of uncompensated care.
A substantial segment of the health care business community believes it’s imperative that more Mississippians get health care insurance.
Some legislators say there’s at least quiet talk about considering Arkansas’ model for covering additional uninsured, eligible residents. That plan, in sum, seeks to take Medicaid funds and use them to purchase private-sector health insurance coverage through the state’s health insurance exchange.
Mississippi has a health insurance exchange constructed and ready to be implemented, but Gov. Bryant, in a disagreement with statewide elected Insurance Commissioner Mike Chaney, refused to take the necessary steps, and the federal Department of Health and Human Services disallowed the exchange.
Chaney moved to create the state exchange on the premise that it would be better for the state to run its own exchange than to have the federal government do it for us.
There’s been no compelling argument to the contrary; Bryant’s decision was clearly political.
In 2009, funding Medicaid came down to the wire in a disagreement involving Gov. Haley Barbour, the Mississippi Hospital Association and various legislative positions. In that situation, however, Barbour lived up to his reputation as a masterful wheeler and dealer in complex policy situations. Medicaid was funded.
Similar flexibility and two-way conversations are essential in 2013 to at least sustain the Medicaid program and fully discuss, as policy, whether or not expansion is in the best interests of eligible Mississippians, the critical but forgotten key element in this whole argument.